Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Risk of Anaphylaxis After Vaccination

A look at adults and new vaccines in children

Publish date:: October 20, 2015

While anaphylaxis after vaccination proved rare in all age groups, it is a potentially life-threatening medical emergency that clinicians need to be prepared to treat, according to a study of adults and children and more than 2 million vaccine doses. Among these doses, there were 33 confirmed vaccine-triggered anaphylaxis cases. The study also found:

• Vaccine-specific rates of anaphylaxis included 1.35 per million doses for inactivated trivalent influenza vaccine (10 cases) and 1.83 per million doses for inactivated monovalent influenza vaccine (2 cases).

• Onset of symptoms among cases was within 30 minutes (8 cases), 30 to <120 minutes (8 cases), 2 to <4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases).

• Incidence did no vary significantly be age.

Citation: McNeil MM, Weintraub ES, Duffy J, et al. Risk of anaphylaxis after vaccination in children and adults. [Published online ahead of print October 6, 2015]. J Allergy Clin Immunol. doi:10.1016/j.jaci.2015.07.048.

Commentary: Anaphylaxis, while relatively uncommon, has a lifetime prevalence of 1.6% to 5.1% of adults in the United States¹. As such, it is something that most of us as primary care physicians will encounter in our practices. Common triggers include: foods such as peanuts, tree nuts and shellfish; medicines including antibiotics and NSAIDs; and miscellaneous allergens. The treatment of first choice is epinephrine. This study shows that while anaphylaxis can occur after vaccine administration, it is an extremely rare event. —Neil Skolnik, MD

1. Wood RA, Camargo CA, Lieberman P, et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol 2013;133:461-7.

This Week's Must Reads

Younger adults present with more advanced esophageal adenocarcinoma,

Osteoporosis prevalence in PsA similar to general population,

Mortality risks rise with age, infections, but not inhibitor status in persons with non-severe hemophilia A,

DOACs look safe in elective endoscopic procedures,

Anorexia and diarrhea top list of GI symptoms in COVID-19 patients,

Must Reads in Immunology

Trial of epicutaneous immunotherapy in eosinophilic esophagitis,

Azithromycin prevents airway complications of antibody deficiency,

Ligelizumab Maintains Urticaria Control For Up to 1 Year,

Novel transplant regimen improves survival in primary immunodeficiency,

Penicillin Allergy & Risk of MRSA and C. difficle, BMJ; ePub 2018 Jun 27; Blumenthal, et al